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NAPLEX Review > Pain > Flashcards

Pain Flashcards

1
Q

When does nociceptive pain occur?

A

when sensory nerves identify tissue damate

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2
Q

What analgesics should be used for mild, moderate, and severe pain?

A

Mild: non-opioid +/- adjuvant
Moderate: Opioid +/- non-opioid +/- adjuvant
Severe: higher dose or stronger opioid +/- non-opioid +/- adjuvant

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3
Q

APAP effects and MOA

A

Reduces pain and fever
Does NOT provide anti-inflammatory effects
Thought to inhibit PG synthesis

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4
Q

Pediatric APAP dosing

A

10-15 mg/kg q4-6h

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5
Q

What dose of APAP when used chronically affect INR?

A

> 2g/d

Increase INR

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6
Q

What is included in all non-aspirin NSAID MedGuides?

A

GI risk: bleeding and ulcerations
CV risk: increased risk of MI and stroke
CABG surgery: NSAID use is CI after CABG (ASA is recommended tho)

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7
Q

How can NSAIDs contribute to renal failure?

A

Decrease blood flow to glomerulus

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8
Q

SE of all NSAIDs

A

Decrease renal clearance - caution/avoid in renal failure
Increase BP
Can cause HF in baby - do not use in third trimester
Nausea
Photosensitivity

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9
Q

What negative effect can occur if NSAIDs are taken during the third trimester of pregnancy?

A

Premature closing of the ductus arteriosus (DA)

The DA allows oxygenated blood to flow to the baby, bypassing the immature lungs

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10
Q

Which NSAID has high risk for CNS side effects?

A

Indomethacin (Indocin)

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11
Q

Ibuprofen pediatric dosing

A

5-10 mg/kg q6-8h

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12
Q

Ketorolac BBW and warnings

A

BBW: max of 5 days
warnings: ARF, liver failure

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13
Q

What medications are non-selective NSAIDs?

A 
Ibuprofen
Indomethacin
Naproxen
Ketorolac
Piroxicam
Sulindac
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14
Q

What medications are COX-2 selective NSAIDs?

A 
Celecoxib (Celebrex)
Diclofenac (Voltaren)
Meloxicam (Mobic)
Etodolac
Nabumetone
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15
Q

Celecoxib CI and notes

A

CI: sulfonamide allergy
Notes: highest COX-2 selectivity

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16
Q

Diclofenac + misoprostol (Arthrotec) BBW

A

Avoid in women of childbearing potential

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17
Q

Opioid MOA

A

mu receptor agonist in CNS - results in pain relief but can cause euphoria and respiratory depression

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18
Q

Opioid BBW

A

Addiction, abuse and misuse can lead to death
Respiratory depression
Avoid with benzo or other CNS depressants

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19
Q

Common opioid medications

A 
Codeine
Fentanyl (Duragesic)
Hydrocodone
Hydromorphone (Dilaudid)
Methadone (Dolophine)
Meperidine (Demerol)
Morphine
Oxycodone
Oxymorphone
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20
Q

Codeine BBW, CI, and SE

A

BBW: Respiratory depression and death in children following tonsil and/or adenoid removal who are found to be rapid metabolizers d/t CYP2D6 polymorphism
CI: children <12 (any indication) and 18 (following tonsil/adenoid surgery)
SE: high instance of constipation

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21
Q

What CYP enzyme metabolizes codeine

A

2D6

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22
Q

Fentanyl BBW, SE, notes

A

BBW: Use with strong or moderate CYP3A4 inhibitors
SE: application site redness (patch)
Notes: do not use in opioid naive patients; dispose of patch in toilet

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23
Q

How often to apply fentanyl patch

A

every 72 hours

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24
Q

A patient on what dose of morphine can be converted to fentanyl patch?

A

morphine 60mg/d x 7 days

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25
Q

Hydrocodone BBW

A

Starting CYP3A4 inhibitors or stopping inducers can cause fatal overdose

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26
Q

Hydromorphone BBW and notes

A

BBW: medication error with high potency injection
Notes: very potent - high risk of overdose

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27
Q

Methadone BBW and notes

A

BBW: risk of QT prolongation and serious arrhythmias have occurred
Notes: variable half-life, can decrease testosterone

28
Q

Meperidine (demerol) Warning and notes

A

Warning: renal impairment - elderly at risk for CNS toxicity; avoid within 2 weeks of MAOi
Notes: No longer recommended as an analgesic
Can cause seizures if impaired renal function
Serotonergic

29
Q

Morphine side effects

A

Itching!

Can give diphenhydramine

30
Q

Oxycodone BBW and SE

A

BBW: Initiation of CYP3A4 inhibitor or d/c inducer can cause fatal overdose
SE: itching, dry mouth, hyperhidrosis

31
Q

Oxymorphone

A

Tablet

Take on empty stomach

32
Q

When converting between opioid medications, how much should you reduce the dose?

A

25%

If NAPLEX does not say to reduce, do not reduce?

33
Q

Morphine IV:PO conversion

A

10:30
IV:PO

34
Q

Morphine to hydromorphone IV:PO conversion

A

10: 30 - morphine IV:PO

1. 5:7.5 - hydromorphone IV:PO

35
Q

What opioids have cross reactivity?

A

CODeine, hydroCODone, oxyCODone

MORPHine, hydroMORPHone, oxyMORPHone, BupreNORPHine, heorine

36
Q

What are first-line laxative for constipation caused by opioid use?

A

Stimulant laxatives +/- stool softener

Can use Peripherally-acting mu-opioid receptor antagonist (PAMORA) or lubiprostone if laxative is ineffective

37
Q

Treatment options for opioid induced constipation?

A

Methylnaltrexone (Relistor)
Naloxegol (Movantik)
Lubiprostone (Amitiza)

38
Q

Peripherally-acting mu-opioid receptor antagonist (PAMORA) MOA

A

block opioid receptors in the gut to reduce constipation without affecting analgesia

39
Q

Methylnaltrexone (Relistor) warning and SE

A

Warnings: GI performation
SE: abdominal pain, flatulence

40
Q

Naloxegol (Movantik) warning and SE

A

Warning: GI perforation
SE: abdominal pain, flatulence

41
Q

What medications are mu-opioid receptor agonists and inhibitors of NE reuptake?

A

Tramadol (Ultram) and Tapentadol

42
Q

Tramadol warning, CI, SE, and notes

A

Warnings: Seizure risk, serotonin syndrome risk when used with CYP2D6 or 3A4 inhibitors
CI: children <12 or children <18 following tonsillectomy/adenoidectomy
SE: dizziness, constipation, nausea, somnolence

43
Q

What CYP enzyme metabolizes tramadol into its active form?

A

2D6

44
Q

What opioid medications are manufactured using specific technology designed to deter crushing, dissolving, or other modifications?

A

OxyContin

Hysingla ER

45
Q

What are opioid-induced respiratory depression (OIRD) risks?

A

Hx of previous overdose
Substance abuse
Using large doses (50 or more morphine milligram equivalent dose)
Using with benzos, gabapentin, or pregabalin
Comorbid illness such as respiratory and psychiatric disease

46
Q

Buprenorphine MOA

A

partial mu-opioid agonist
Agonist at low doses
Antagonist at high doses

47
Q

How is naloxone available?

A

Evzio (auto-injector)
Narcan (nasal spray)
Naloxone (injection)

48
Q

Buprenorphine schedule, disposal, application, notes

A

Schedule C-III
Disposal: fold sticky sides together, flush
Apply every week
To prescribe needs DATA 2000 waiver - DEA issues a unique identification number to the prescriber starting with X

49
Q

What can be used to cover a buprenorphine patch?

A

Bioclusive or Tegaderm - approved film dressings

50
Q

What are oral adjuvants for neuropathic pain?

A 
Gabapentin
Pregabalin (C-V)
Carbamazepine (Tegretol)
Milnacipran
Amitriptyline
Desipramine
Duloxetine
51
Q

What are oral adjuvants for musculoskeletal pain/spasms

A 
Baclofen
Cyclobenzaprine
Tizanidine (Zanaflex)
Carisoprodol
Metaxalone
Methocarbamol
52
Q

What are topical adjuvants for pain?

A 
Lidocaine 5% patches
Lidocaine viscous gel
Capsaicin (Zostrix)
Methyl salicylate (BenGay, Icy Hot, SalonPas)
53
Q

Neurontin vs Horizant indication

A

Neurontin - nerve pain

Horizant - PHN and restless leg syndrome

54
Q

What does PHN mean?

A

Postherpetic neuralgia

55
Q

Gabapentin SE, warnings

A

SE: Dizziness, somnolence, peripheral edema
Warnings: Angioedema/anaphylaxis, DRESS, CNS depression

56
Q

Pregabalin SE, warnings, ntoes

A

SE: Dizziness, somnolence, peripheral edema, weight gain, mild anxiolytic
Warnings: Angioedema/anaphylaxis, CNS depression
Notes: Approved for use in fibromyalgia, PHN and neuropathic pain

57
Q

Carbamazepine (Tegretol) is the only FDA approved medication for what

A

Trigeminal neuralgia

58
Q

Baclofen SE

A

Excessive sedation, dizziness, confusion, asthenia (muscle weakness)

59
Q

Cyclobenzaprine SE and notes

A

SE: dry mouth
Notes: serotonergic

60
Q

Tizanidine (Zanaflex) SE

A

Hypotension, dry mouth

61
Q

Carisoprodol note

A

Poor CYP2C19 metabolizers with have increased concentrations (up to 4 fold)
Rapid metabolizers will have increased active metabolite

62
Q

What is dantrolene (Dantrium) used for?

A

Malignant hyperthermia

63
Q

Lidocaine patch noates

A

Can cut into smaller pieces (before removing backing)
Lidoderm: do not apply more than 3 patches at one time
Caution with used patches, can harm children and pets

64
Q

Diclofenac gel dosing

A

Hands, wrists, elbows - 2g 4x/d - max 8g/d
Feet, ankles, or knees - 4g 4x/d - max 16g/d
Do not shower, bathe or wash treated hands for 1 hour after application

65
Q

Key counseling points for capsaicin

A

Wash hands thoroughly with soap and water after use
If treating hands, leave on for 30 minutes then wash hands
Do not touch genitals, nasal area, mouth or eyes with the medicine, will burn sensitive skin
Burning pain should dissipate with continued use
Do not cover with heating pads, electric blankets, or bandages, serious burning can occur

NAPLEX Review (79 decks)

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